Although a review of the recent literature found that the evidence for a causal association between mobile phone use while driving and crash related injuries was not clear cut,1 with a quarter of crashes in the United States now attributed to mobile phone use, we can’t wait for perfect evidence before acting.2

In 1997, Redelmeier and Tibshirani found that mobile (cell) phone use was associated with a quadrupled risk of crashes,3 although last year a study cast doubt on some components of the association.4 While most early studies unequivocally supported the view that mobile phones made driving more dangerous, some later reports arrived at contradictory conclusions, especially with regard to hands-free phones.5 Part of the confusion may be due to the mix of laboratory and observational epidemiological studies that characterise this field. Nevertheless, given the proliferation of mobile phones, the prevalence of distracted driving is undoubtedly increasing.

Texting is obviously the riskiest activity because the distraction is cognitive and visual; handheld phone use (particularly when making or receiving calls) comes next; and hands-free use is probably the least …

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